Is A.D.H.D. Misunderstood? New Data and Perspective on Diagnosis and Treatment

The below is based on an article by Paul Tough. It was published on April 13, 2025 in the New York Times Magazine.

Attention Deficit Hyperactivity Disorder (A.D.H.D.) diagnoses are at an all-time high, with 11.4% of American children—7 million kids—carrying the label in 2023, a sharp rise from 2 million in the 1990s. Alongside this surge, prescriptions for stimulant medications like Ritalin and Adderall have skyrocketed, increasing 58% from 2012 to 2022. But as the numbers climb, a growing chorus of experts is questioning whether we’ve been approaching A.D.H.D. correctly, challenging the assumption that it’s a purely biological disorder requiring a medical fix.

The Rise of A.D.H.D. and the M.T.A. Study

In the early 1990s, James Swanson, a research psychologist at UC Irvine, found himself at the center of a contentious debate. The Church of Scientology was protesting Ritalin, the go-to A.D.H.D. medication, accusing psychiatry of “drugging kids.” At the time, A.D.H.D. diagnoses doubled from under a million in 1990 to over two million by 1993, with most children prescribed Ritalin. Swanson, believing 3% of kids had A.D.H.D., saw this as appropriate.

To address questions about Ritalin’s efficacy, Swanson led the Multimodal Treatment of Attention Deficit Hyperactivity Disorder (M.T.A.) study, a landmark trial comparing stimulants, behavioral therapy, and combined approaches. Initial results in 1999 showed Ritalin significantly reduced symptoms after 14 months compared to behavioral therapy alone, cementing its use. However, by 36 months, all groups—including those without treatment—had similar symptom levels, revealing no long-term behavioral benefits. Worse, children on Ritalin grew about an inch shorter on average, a gap that persisted into adulthood.

Swanson, now 80, is troubled by these findings and the A.D.H.D. field’s direction. “There are things about the way we do this work that just are definitely wrong,” he says.

Challenging the Medical Model

The traditional view of A.D.H.D. as a fixed, brain-based disorder—often compared to “diabetes of the brain”—is losing ground. Edmund Sonuga-Barke, a researcher at King’s College London, notes a disconnect: “We have a clinical definition of A.D.H.D. that is increasingly unanchored from what we’re finding in our science.” Despite decades of searching, no reliable biological marker (like a brain scan or genetic test) confirms A.D.H.D. as a distinct condition. The 2017 Enigma Consortium study, for instance, found negligible brain differences in A.D.H.D. patients, undermining claims of a clear neurological basis.

Sonuga-Barke argues A.D.H.D. symptoms exist on a continuum, not as a binary “you have it or you don’t” condition. Environmental factors—like trauma, anxiety, or an unsuitable setting—can mimic or exacerbate symptoms, complicating diagnosis. Over 75% of kids with A.D.H.D. have another mental health condition, such as anxiety or a learning disorder, blurring the lines further.

Medication’s Limits

Stimulants like Ritalin and Adderall, rooted in a 1937 discovery by psychiatrist Charles Bradley, remain the standard treatment. They often produce striking short-term behavioral improvements, described by researcher F. Xavier Castellanos as “almost mystical.” Yet, studies consistently show they don’t enhance academic performance. A 2023 study by Elizabeth Bowman found adults on stimulants worked harder on cognitive tasks but performed no better than those on placebos. A 2022 study by William Pelham Jr. showed similar results in children: better behavior, but no learning gains.

Why do families still rely on these drugs? Research by Martha Farah suggests stimulants boost confidence and motivation, making boring tasks feel engaging. As sociologist Scott Vrecko found, students describe falling “in love” with their work on Adderall, not because it sharpens their intellect but because it makes tedious tasks tolerable—a phenomenon historically seen in soldiers, housewives, and truckers using amphetamines to endure monotony.

But the downsides are significant. Beyond growth suppression, stimulants carry risks of addiction and, per a 2024 study, tripled odds of psychosis or mania at medium doses. Many teens, like “Cap” and “John,” dislike the emotional flattening or appetite loss, often stopping medication outside school. Cap used Ritalin situationally for SAT prep and baseball, while John felt “completely regular” without Adderall in summer, highlighting A.D.H.D.’s context-driven nature.

A New Perspective: Environment Matters

Recent M.T.A. studies reveal A.D.H.D. symptoms fluctuate over time, with only 11% of diagnosed kids showing consistent symptoms year after year. Margaret Sibley notes that 40% of non-A.D.H.D. kids in the study later met diagnostic criteria, suggesting environmental changes—like a demanding school—can trigger symptoms. A.D.H.D., it seems, isn’t always a fixed disorder but a condition shaped by context.

In 2016, M.T.A. researchers interviewed young adults who had A.D.H.D. as kids. Many reported their symptoms vanished after finding a “niche”—a career or study path aligning with their interests, like film, hairstyling, or auto repair. These environments, whether cognitively demanding or hands-on, felt “intrinsically interesting,” reducing distraction. Sibley found symptoms often improved during high-demand periods, challenging the idea that A.D.H.D. worsens under pressure.

Sonuga-Barke proposes a new model: A.D.H.D. symptoms signal a mismatch between a person’s biology and environment, not a brain defect. He advocates building supportive settings—like engaging schools or jobs—over relying solely on medication. This approach, he argues, improves mental health and self-esteem, reducing the stigma of being “defective.”

The Stigma of Diagnosis

Labeling A.D.H.D. a “brain disorder” can backfire. While some families find a diagnosis empowering, Luise Kazda’s 2021 review found it often increases shame and isolation, fostering an identity tied to prejudice. Sonuga-Barke’s model, by contrast, frames A.D.H.D. as a trait on a spectrum, encouraging families to explore environmental tweaks—like a new school—or address co-occurring issues like anxiety, alongside medication if needed.

A Path Forward

Rethinking A.D.H.D. as a contextual condition requires flexibility from families and doctors, but it offers hope. It aligns with science showing symptoms aren’t fixed and empowers kids to see themselves as “different, not defective.” For some, medication may help navigate tough environments; for others, finding the right niche could be transformative. As Sonuga-Barke reflects from his own A.D.H.D. journey—thriving in college after struggling in school—the key is creating a world that fits the unique wiring of each mind.

Paul Tough is a contributing writer for The New York Times Magazine, focusing on education and child development for over two decades.

Managing ADHD in Adults: Understanding Symptoms and Coping Strategies

Living with ADHD as an adult can feel like navigating a maze with moving walls. You might struggle to finish tasks, stay organized, or find the motivation others seem to access effortlessly. If you’ve ever felt guilt or frustration over incomplete projects or restless energy, you’re not alone. Adult ADHD is real, and while it presents challenges, there are practical ways to work with your brain to thrive. Let’s explore what ADHD looks like in adults and share strategies to manage its symptoms effectively.

What Is Adult ADHD?

ADHD (Attention-Deficit/Hyperactivity Disorder) isn’t just a childhood condition. While many are diagnosed as kids, symptoms often persist into adulthood, and some people aren’t diagnosed until later in life. Adult ADHD can manifest as difficulty focusing, impulsivity, or restlessness, but it’s not always the “hyperactive” stereotype. There are three main types:

  • Predominantly Inattentive: Struggling with focus, organization, or completing tasks.

  • Predominantly Hyperactive-Impulsive: Acting on impulse or feeling restless.

  • Combined: A mix of both inattentive and hyperactive-impulsive symptoms.

For most adults, ADHD symptoms don’t vanish entirely, but they can evolve. You might not be climbing furniture like you did as a kid, but you could find yourself restless, bored, or jumping between projects without finishing them.

Common Symptoms of Adult ADHD

Here’s how ADHD might show up in your daily life:

  • Inattention:

    • Making careless mistakes due to trouble focusing on details.

    • Struggling to stay focused during work, conversations, or leisure.

    • Seeming to “tune out” when spoken to directly.

    • Having difficulty following through on instructions or finishing tasks.

    • Struggling to organize tasks, time, or belongings.

    • Avoiding tasks requiring sustained mental effort, like paperwork.

    • Frequently losing items like keys, wallets, or phones.

    • Getting easily distracted by external stimuli or wandering thoughts.

    • Forgetting daily responsibilities, like appointments or bills.

  • Hyperactivity and Impulsivity:

    • Feeling restless or fidgety, like you can’t sit still.

    • Interrupting others or blurting out thoughts impulsively.

    • Struggling to wait your turn in conversations or situations.

    • Starting new projects before finishing existing ones.

    • Seeking constant stimulation or novelty.

These symptoms can lead to frustration, low self-esteem, or challenges in relationships and work. But understanding them is the first step to managing them.

Coping Strategies for Adult ADHD

There’s no one-size-fits-all cure for ADHD, but you can harness your brain’s unique wiring—its love for novelty, creativity, and energy—to build a more productive and fulfilling life. Here are practical strategies to cope with ADHD symptoms:

1. Embrace Your Strengths

The ADHD mind thrives on excitement and creativity. Instead of fighting it, lean into it. Approach tasks from fresh angles or use new tools to make routine work feel engaging. For example, if paperwork feels daunting, try gamifying it with a timer or colorful organization apps to spark interest.

2. Break Tasks Into Small Steps

Big goals can feel overwhelming. Break them into bite-sized, actionable steps and commit to one small action daily. For instance, instead of “organize my desk,” start with “sort one drawer today.” Small wins build momentum and make larger goals feel achievable.

3. Set Realistic Goals

Dream big, but start small. Setting unattainable goals can lead to frustration. Instead, create specific, measurable targets—like “spend 10 minutes on emails each morning.” Consistently hitting small goals fosters habits that pave the way for bigger successes.

4. Create Structure and Routines

ADHD brains often resist rigid routines, but flexible structure can help. Use tools like planners, apps, or visual reminders to stay on track. For example, set phone alarms for key tasks or use a whiteboard for daily priorities. Keep routines simple to avoid overwhelm.

5. Minimize Distractions

Identify what pulls your focus—phone notifications, noisy environments, or cluttered spaces—and take steps to reduce them. Try noise-canceling headphones, turn off non-essential notifications, or designate a distraction-free workspace for important tasks.

6. Use Timers and Time-Blocking

Time management can be tough with ADHD. Techniques like the Pomodoro method (working for 25 minutes, then taking a 5-minute break) can keep you focused. Time-blocking—assigning specific time slots to tasks—also helps you stay on track without feeling trapped.

7. Seek Support

You don’t have to navigate ADHD alone. Consider working with a therapist, coach, or support group specializing in ADHD. They can offer tailored strategies and accountability. If appropriate, consult a healthcare provider about medication options, which can help manage symptoms for some.

8. Practice Self-Compassion

ADHD can make you feel like you’re falling short, but beating yourself up drains energy. Accept your limitations and focus on what you can do. Celebrate progress, no matter how small, and remind yourself that ADHD is a neurological difference, not a personal failure.

Turning Challenges Into Opportunities

Adult ADHD can make life feel like a constant juggling act, but it also comes with unique strengths—like creativity, enthusiasm, and out-of-the-box thinking. By understanding your symptoms and experimenting with strategies that align with your brain’s wiring, you can turn challenges into opportunities. Over time, you’ll build systems and habits that help you tackle daily tasks and pursue your goals with confidence.

If you’re struggling, know that you’re not alone, and small changes can make a big difference. Start with one strategy, tweak it to fit your life, and watch how your ADHD mind can shine.

Ready to Take the Next Step?

Explore ADHD-friendly tools like task apps (e.g., Todoist, Trello) or connect with a professional to create a personalized plan. Your journey with ADHD is unique—embrace it, and find what works for you!

Joining us July 7: Kelly Dodson, MA

We are thrilled to announce that Kelly Dodson will be joining our team soon!

Kelly understands that sometimes we feel overwhelmed by the ups and downs of life, like a kaleidoscope of shifting emotions and experiences. Whether you’re an adult trying to have everything "figured out," a teenager navigating daily pressures, or a college student juggling school and life, it can be a lot to handle. Kelly’s approach to therapy is person-centered and strengths based, emphasizing that the client has within them the resources needed to overcome life’s challenges; it is a matter of uncovering and utilizing these skills. She has a personable, easy-going mindset and utilizes skills such as mindfulness, motivational interviewing, and reflective listening to hold space for clients to change in their own way and at a pace that is comfortable for them.

Kelly graduated with her bachelor’s degree in Psychology from the University of North Georgia and then continued on to receive a master’s degree in Professional Counseling from Liberty University. In her spare time Kelly loves to read, write, spend time outdoors, and spend time with her family and three cats. Kelly is receiving clinical supervision from a qualified, licensed supervisor until completion of full licensure.  

Breaking the Stigma: Why Therapy Is Strength, Not Shame

Let’s talk about something that’s been a bit of a heavy topic for way too long—therapy. I know, I know, there’s this old, stubborn stigma that makes it feel like reaching out for help with our mental health is something to be ashamed of. But honestly, that’s such a shame because we humans? We’re wired for connection. We need each other, like, deep in our bones, to get through life’s ups and downs.

Still, somehow, society has convinced so many of us that we should go it alone. Like, if we just hide our struggles—our pain, our messy emotions, all the stuff that keeps us from feeling truly happy—we’re being strong. But let’s be real: that’s not strength. That’s just pretending, and it doesn’t make the hard stuff disappear. We’re human, not superheroes! Having emotions isn’t a flaw—it’s what makes us, us.

Here’s the thing: when we shove our feelings down, they don’t just vanish. They build up, like toxic gunk, and over time, that can really mess with our wellbeing—and even spill over onto the people we love. But talking to a therapist? It’s like opening a window to let all that heavy stuff out so it doesn’t drag us down. Therapy gives us a safe space to dig into the messy parts of ourselves, to figure out what’s really going on inside. Sometimes, we even uncover old hurts we didn’t realize were dimming our light—and that’s when the healing starts.

There’s nothing wrong with having emotions, and there’s definitely nothing wrong with asking for help to navigate them. Honestly, it takes a lot of guts to say, “I need support,” and I think that’s something pretty amazing. So, let’s ditch the shame and embrace the fact that we’re all in this together, okay?

Joining us in May: Alissa Krueger

Alissa is joining Birch Counseling as a graduate student intern from St. Mary’s University in the Counseling and Psychological Services program. She has over 15 years of experience in diverse administrative roles, collaborating with people from various backgrounds.

Alissa offers a warm, compassionate, and safe space to explore what matters most to clients. She believes every client deserves to feel heard, seen, and validated. She values humor to build connections and create a supportive space for growth.

Alissa works with adults, older adolescents, and couples. She uses an integrative approach that includes aspects of acceptance and commitment therapy, narrative therapy, motivational interviewing, and feminist therapy. As a mother, Alissa has a special interest in supporting individuals experiencing pregnancy and postpartum depression and anxiety. She is passionate about helping new parents navigate the challenges of expanding their family.

In her free time, Alissa enjoys reading at coffee shops, making arts and crafts with her children, and taking advantage of the many Minnesota lakes.  

Welcoming in June: Maddy Fiksdal, MA

Maddy has experience working in various roles and settings with adults and adolescents. She graduated with a master’s degree in Counseling for Co-Occurring Disorders from Hazelden Betty Ford Graduate School of Addiction Studies. She is a Licensed Alcohol and Drug Counselor (LADC) and is currently under supervision while working toward Licensed Professional Clinical Counselor (LPCC) licensure.

Maddy is passionate about working with individuals ages 15+ who are experiencing trauma, addiction, anxiety and particularly enjoys working members of the LGBTQIA+ community. Maddy uses a person-centered lens and brings curiosity, empathy, compassion, and humor to her work. She creates a safe environment and builds strong therapeutic relationships. Cognitive Behavioral Therapy (CBT) and Mindful Self-Compassion (MSC) interventions are frequently used tools. Maddy is trained in Eye Movement Desensitization and Reprocessing (EMDR).

Outside of work, Maddy enjoys spending time with friends and family. She loves crossword puzzles, watching movies, and reading. Maddy enjoys rock climbing and tries to be outdoors as much as possible.

JOINING US IN AUGUST: SONIA COBOS, MS

Sonia (she/her) is passionate about mental health and behavioral science and considers herself privileged to work in this field.  Sonia recently completed a Master’s degree in rehabilitation and addiction counseling. Her training was focused on addiction and mental health counseling, including the special needs of individuals living with disability, congenital or acquired.

Sonia takes a holistic and goal-oriented Adlerian approach. Informed by this perspective, Sonia believes that the person’s wholeness or holistic nature is irreducible, therefore considering parts of the personality while ignoring others undermines the understanding of the individual. Sonia likes to apply contextual psychology, family system theory, cognitive behavioral therapy, and motivational interviewing in her practice.

As an immigrant, Sonia is mindful of cultural influences as well as the trauma and generational trauma experienced by the immigrant and first and second generation Americans. She approaches multiculturalism as an enriching opportunity to expand our humanity and grow consciousness.

Sonia’s clinical training is patient centered and non-directive. Sonia’s research during graduate school was in neuroplasticity and the promotion of neurogenesis as part of the therapeutic approach for individuals with addictions and co-occurring mental illness.

Sonia enjoys working with individuals of all ages and backgrounds, and has special interest in helping those who experience addictions, domestic violence, developmental trauma, PTSD, grief and traumatic grief, and patients with long-term disability.

Announcing Men's Support Group: Swinging from Birches

We are pleased to announce the beginnings of a new support group, which will be facilitated by Birch Counseling provider Brian Rose, MA, LADC. This group is welcoming men who are facing questions about substance use as well as other pertinent life problems. The group will be held on Monday evenings, 5:00 - 6:30pm at our Hopkins location (904 Mainstreet, #200). If you are interested in becoming a member, please contact our front office at (866) 522-2472, ext. 0. They will be happy to schedule a pre-admission meeting with Brian, who will make sure you are a good fit for the group. This men’s group will be limited to a maximum of 8 active members.

Below is Brian Rose’s description of the group:

The pandemic has been tough. It has broken our connection with many sources of support and the routines that anchored us. This group’s purpose is to connect with other men for support to help answer questions about issues that have arisen in our lives, such as questions about substance use, interpersonal relationships, as well as anxiety and depression. While such issues may have predated the pandemic , the isolation of the lock-downs has made these concerns more visible and pressing for many.

Some of the topics discussed in this group will cover substance use, improving communication in our relationships, repairing connections with friends and family, coping with symptoms of anxiety and depression, and the facing lonliness that has increased with isolation. This will be a process group with a strong focus on learning to connect and trust others.

The group will meet Mondays, from 5:00pm to 6:30pm, in person. 

Birches

Poem by Robert frost

When I see birches bend to left and right
Across the lines of straighter darker trees,
I like to think some boy's been swinging them.
But swinging doesn't bend them down to stay
As ice-storms do. Often you must have seen them
Loaded with ice a sunny winter morning
After a rain. They click upon themselves
As the breeze rises, and turn many-colored
As the stir cracks and crazes their enamel
Soon the sun's warmth makes them shed crystal shells
Shattering and avalanching on the snow-crust —
Such heaps of broken glass to sweep away
You'd think the inner dome of heaven had fallen.
They are dragged to the withered bracken by the load,
And they seem not to break; though once they are bowed
So low for long, they never right themselves:
You may see their trunks arching in the woods
Years afterwards, trailing their leaves on the ground
Like girls on hands and knees that throw their hair
Before them over their heads to dry in the sun.
But I was going to say when Truth broke in
With all her matter-of-fact about the ice-storm
I should prefer to have some boy bend them
As he went out and in to fetch the cows —
Some boy too far from town to learn baseball,
Whose only play was what he found himself,
Summer or winter, and could play alone.
One by one he subdued his father's trees
By riding them down over and over again
Until he took the stiffness out of them,
And not one but hung limp, not one was left
For him to conquer. He learned all there was
To learn about not launching out too soon
And so not carrying the tree away
Clear to the ground. He always kept his poise
To the top branches, climbing carefully
With the same pains you use to fill a cup
Up to the brim, and even above the brim.
Then he flung outward, feet first, with a swish,
Kicking his way down through the air to the ground.
So was I once myself a swinger of birches.
And so I dream of going back to be.
It's when I'm weary of considerations,
And life is too much like a pathless wood
Where your face burns and tickles with the cobwebs
Broken across it, and one eye is weeping
From a twig's having my lashed opened.
I'd like to get away from earth awhile
And then come back to it and begin over.
May no fate willfully misunderstand me
And half grant what I wish and snatch me away
Not to return. Earth's the right place for love:
I don't know where it's likely to go better.
I'd like to go by climbing a birch tree,
And climb black branches up a snow-white trunk
Toward heaven, till the tree could bear no more,
But dipped its top and set me down again.
That would be good both going and coming back.
One could do worse than be a swinger of birches.

Joining us July 1: Laura Linner, MA, LICSW

Laura (she/her) genuinely loves this work and brings authenticity, hope and humor to sessions with individuals and families. She considers it an honor to have the opportunity to walk alongside others in recognizing, accessing, and developing their own resiliency, and in building a rich, full and meaningful life (as they define it!). Laura is mindful of creating a non-judgmental, anti-oppressive, anti-racist, LGBTQIA-affirming space for the clients with whom she works. She views therapy as a collaborative process and values feedback from clients.

Laura’s foundational clinical training is in non-directive Rogerian client-centered therapy from her time as a clinical intern then post-graduate psychotherapy fellow in a group practice in Chicago. This humanistic approach continues to serve as the clinical underpinning of her work with clients. That being said, Laura takes an eclectic approach and aligns with concepts of clinical pragmatism – offering and using what therapeutic intervention works - tailored to each individual. Laura sees therapy as an opportunity to pause, reflect, and take an inventory of how our lives are going, identify what’s working and what isn’t, and make effective change in moving closer to the life we hope for ourselves. Laura brings an attitude of openness, curiosity and compassion with clients. She has benefitted greatly from her own therapy over the years and strives to provide a similarly beneficial experience to those with whom she has the honor of working with.

Laura is trained in, integrates, and draws from a number of therapeutic approaches including Acceptance and Commitment Therapy, Cognitive Behavioral Therapy, trauma-informed therapy (TF-ACT and TF-CBT), CBT for psychosis (CBT-p), ACT for psychosis, psychodynamic theory, polyvagal theory, motivational interviewing, harm-reduction, and also employs a neuroscientific lens to reinforce concepts of regulation, zones of optimal functioning and neuroplasticity/opportunity for growth and change. Laura is also trained in child-centered play therapy from when she worked with youth impacted by domestic violence.

Laura completed her graduate degree in clinical social work at The University of Chicago’s School of Social Service Administration. For the past four years, Laura has worked for the University of Minnesota Department of Psychiatry as an individual and family therapist specializing in first-episode psychosis and schizophrenia spectrum disorders. She has a passion for working with individuals and families in processing new diagnoses and identifying ways of being that work for all who are impacted in their own unique ways. Prior to this, Laura has experience providing therapy and support to individuals in life transitions, relationship challenges, identity exploration and development, finding a sense of meaning and purpose, working through grief and loss, coping with the impact of domestic violence and trauma, and effectively coping with life stressors. She has also worked both internationally and stateside in violence recovery services and human rights work. Diagnostically, Laura has experience working with individuals who have been diagnosed with anxiety, depression, PTSD, OCD, disordered eating, substance use disorders, mood disorders, dissociative disorders, and schizophrenia spectrum disorders.

Laura believes an individual is not their diagnosis, and joins alongside clients to explore meaning of diagnosis in a way that is adaptive and feels authentic to them.

Laura believes life and humans can be messy, confusing, amazing, doubtful, inspired, worried, scared, brave, determined, hopeless, hopeful and many more things all at the same time. Laura is inspired by people’s willingness and ability to move into discomfort, try new ways of being and make change in ways that feel valuable to them, and she is grateful for being able to provide support along the way.

When Laura isn’t working she enjoys reading, spending time with family and friends, snuggling her two cats, needlepointing, watching cooking shows, trying to learn to cook herself, playing outside and learning.

 

 

 

Welcoming in December: Amber Phelps

Amber (they/them) is a Licensed Alcohol and Drug Counselor (LADC) and working toward becoming Licensed Professional Clinical Counselor (LPCC). They are passionate about working with individuals, families, and couples by utilizing harm reduction, trauma-responsive care, and providing culturally affirming therapy to help people embrace recovery from a holistic approach. They are trained in Eye Movement Desensitization and Reprocessing (EMDR) to help survivors of trauma manage symptoms and to assist people to discover their hope from within to achieve their recovery goals. Amber uses a collaborative approach to therapy and is experienced with treating and diagnosing PTSD, depression, anxiety, dissociative disorders, substance use disorders, mood disorders, and schizophrenia spectrum disorders.

They have nearly 10 years of varied experience working with survivors of complex and historical trauma, people experiencing homelessness, substance use treatment, crisis intervention, case management, and community-based harm reduction programs. Amber graduated from St. Mary’s University of Minnesota with a MA in Counseling and Psychological Services and a Graduate Certificate in Addiction Studies. In addition to this, Amber has specialization in working with diverse populations as an intersectional, sex-positive, and social justice oriented therapist.

In their free time, Amber enjoys spending time with their family by hiking, thrift shopping, and going to concerts.

Welcoming in September: Alison Campbell, MSW, LICSW

We are very excited to announce the newest addition to the Birch Counseling Team: Alison Campbell, MSW, LICSW!

Alison enjoys working with both adult individuals and couples across the lifespan from all walks of life. She uses a holistic, mind-body perspective and recognizes that a wide range of past and present influences effect both our individual well being and our relationships. With a collaborative, kind and practical approach, Alison helps people explore patterns that may not be serving them and offers guidance and tools for better coping, balance and resiliency so that they can feel more empowered to make the changes they desire. She uses a strengths based, person centered approach with evidence based practices informed by a blend of frameworks. She has had extensive training in mindfulness and somatic practices.

Alison has experience addressing depression, anxiety, stress reduction, trauma, health issues, substance use, relationship difficulties, grief and loss and personal growth. She has lived on both coasts of the US and has worked with people in a variety of settings including low-come housing, correctional facilities, long term care facilities and hospice and community counseling centers. She received her Master’s degree in Social Work from Washington University in St Louis.

Alison has two children, enjoys good books, good cooking, meeting new people and being in the outdoors. She is also a certified yoga teacher.

Alison Campbell photo.jpg

Spotlight with Brian Borre: Metacognitive Therapy

Before we get into theory, or how this approach might apply to you, let’s take a detour into language. When used as a prefix in the English language, “meta-”, stemming from the Greek for “after” or “beyond”, means something that goes beyond, to be all-encompassing, or become transcendent. When “Meta” and “Cognitive” are put together, the result essentially means “thinking about thinking.” For example, have you ever had an experience where you’re certain you know the name of something--a person, product, or place--but you can’t recall it? This “tip of the tongue” experience is just one example of how metacognitions work to inform our everyday lives--we’re thinking about how we’re thinking. While most of our meta-processes aren’t so conscious, our metacognitions are in the background actively controlling and influencing our conscious experience of the world, 

Metacognitive Therapy (MCT) focuses on targeting and modifying our deeply held beliefs--the thinking about our thinking--that fosters states of perpetual worry, rumination, and/or fixation. For example, if you say to yourself, “worrying about this keeps me safe,” or “I have no control over my thoughts,” you are both observing your own thinkingand having thoughts about thinking. The goal of MCT is simple: identify, challenge, and reduce what they dub, “Cognitive-Attentional Syndrome” (CAS). CAS is an umbrella term that refers to the kinds of beliefs that imply: we need worry, are incapable of stopping worry, and would be better off if we hyperfocus on tackling each individual worry.  

You might be thinking to yourself, “Birch Counseling, this is starting to sound a lot like CBT,” (Cognitive Behavioral Therapy). The truth is, you aren’t exactly wrong. In CBT, we are dealing with our thoughts. For example, if we were to use CBT to challenge our social anxiety, we might ask ourselves, “how likely will this outcome be, and will it be as bad as we’re thinking it will be?” Essentially, we identify an irrational thought and we challenge it with a more realistic lens. 

In comparison, with MCT, we are dealing with how we think about our thinking. We don’t give a lot of attention to the individual thoughts. Instead, we challenge the thinking around the thoughts themselves by asking ourselves, “should I spend my time worrying if the worry doesn’t make it less likely to happen? And if I already worried about it and made a decision, why am I re-worrying about this when I don’t have any new information?” This process, which encourages us to refuse to engage with unhelpful thinking, is called “Detached Mindfulness.” It works because it isn’t avoidance--it challenges people to view their worry and irrational beliefs as something that is outside of their core, observe the thoughts, stay non-reactive to them, and choose to respond without the preoccupation with worry about worried thinking. 

Why does Brian like it? Besides being a philosophical guy interested in all things “meta” (emotions, beliefs, and communication), Brian saw that CBT wasn’t always helpful with anxious, depressed, or addiction-driven thinking. From his perspective, it can be equally harmful to hyper-focus on our worry if we feel utterly incapable of controlling or changing it. He thinks about it like “giving in to a screaming toddler you know is just seeking attention because they want something from you, and you don’t know how to handle the upset anymore. Ultimately, it doesn’t help you, or them, to keep caving in or feeling totally helpless to stop it.” Instead, you can learn how to provide the tantruming child in your brain--the anxiety, depression, or addiction monster’s voice--the reassurance that you know what’s best, have a plan, can essentially “pivot” yourself out of the situation, or rebound if you make a mistake. It deflates the tantrum in your brain. And that’s a powerful tool. 

If you think Brian might be a fit for you, or have any additional questions about metacognitive therapy, please feel free to reach out to our team at BizOffice@birchcounseling.com. 

References:

  1. https://mct-institute.co.uk/therapy/

  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6246690/#:~:text=Conclusions%3A%20Our%20findings%20indicate%20that,psychotherapies%2C%20including%20cognitive%20behavioral%20interventions.

  3. https://mental-health-matters.com/what-is-metacognitive-therapy-and-how-can-it-help-anxiety/

  4. https://www.frontiersin.org/articles/10.3389/fpsyg.2017.00031/full

Welcoming in May: Brian Rose, MA, LADC

Brian worked as a professional bicycle mechanic for 29 years. This allowed him to travel around the country and connect with people from all over. He enjoys spending time on the bike, meeting people and trying to learn to fly a drone. 

After working in the bicycle industry for so long he found himself working for a non-profit that focused on underserved communities. He  envisioned doing more for people and decided to change careers. His own journey with mental health and recovery lead him down the path to becoming a counselor. He earned his master’s degree in Addiction counseling and advanced practice from Hazelden Betty Ford Graduate School. He received a Bachelor’s in Psychology with a religious studies minor (focused on Islam) from Hamline University. 

Brian believes that his clients are the experts in their own lives. He brings an existential approach to therapy that focuses on meaning, purpose and personal identity. Brian feels his role in the therapeutic relationship is to create an environment where a sense of safety and acceptance allow for openness and collaboration.  Brian enjoys working with clients on topics around culture, identity and helping find where they meet.

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The Winter is Coming: Managing Mental Health Outside of Therapy

Those ominous words from Game of Thrones have taken on totally new (and dare we say intensified) meaning to Minnesotans this year. In an average year, the National Institute on Mental Health reports that Seasonal Affective Disorder (SAD) impacts millions of Americans annually, lasts 40% of the year, and disproportionately impacts people living in the Northern parts of the country. This year, compounded by the pandemic, people who study and suffer from mental health are expecting this winter to be one of the worst on record. And similar to how hospital beds fill up with patients when there’s a virus outbreak, therapists have started filling up as we start to deal with the first wave of the mental health crisis. 

 So what do you do if you need to supplement therapy, can’t find a therapist, or don’t have the resources to get regular mental health care? We’ve got some tips to help you fight the good fight at home. 

  1. Try An App or Two

  2. Offline Solutions

    • Workbooks: There are so many, it’s hard to know where to start! You can find one based on an issue (anxiety, depression, self-esteem) or pick based on a particular approach that appeals to you (ACT, CBT, DBT). Whichever you choose, these can be great ways to increase insight, coping, and positive change.

    • SAD Lamp: Sure, it may seem silly, but these powerful lamps help you get your daily dose of sunshine, even on the most cloudy of days.

    • Body Maintenance: We all know to eat right, exercise, and take care of our bodies, and try to do it when we have the time and energy to. When we aren't attuned to our bodies, it can be easy to ignore or explain things away that actually might have an organic cause. Going to your doctor and making sure your vitamin levels are at their levels and that we have optimized what we have control over can be empowering. If you think it's needed or appropriate, talk to them about your mood and if any if there are any solutions, natural or pharmaceutical, that might be appropriate. We do maintenance updates on our phones and cars... we might as well do it for ourselves, too.

  3. Done Everything? Try Alternative Solutions:

    • Healing crystals: Change up the energy in your life and ground yourself with some stones

    • Try something natural: Harvard Medical School found some benefits to things like St. John's Wort and Omega-3 Fats for mental health.

    • Try a homeopathic solution: Acupuncture, Massage, and Aroma Therapy might not feel as legitimate, but their benefits have been well researched and studied. If you've tried everything else, it might be worth a new approach.

  4. Get Fancy (When/If Appropriate)

    • Meditate, with training wheels: Use a brain-sensing headband and app combination, like Muse, to give you bio-feedback on how you're doing on your practice of daily meditation.

    • Get your frequency right: Brain stimulators, like Fisher Wallace, can be helpful in treating and managing chronic issues of insomnia, depression, and anxiety.

    • Get your rhythm right: HearMath is a program to get your heart and your brain in sync.

Still unsure about how you're going to make it through the winter, give us a call or email us and we'll be happy to connect you to the right resources for you!

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Stress in a Stressful Time

Even if your life before this year was relatively smooth sailing, likely, you are not making it through this year unscathed. After all, who could mentally prepared for civil unrest, unemployment, natural disasters, and a global pandemic all at once?

The dramatic events of 2020 are especially difficult for those with a trauma history. People with trauma include those whose past is marked by economic insecurity, frequent moving, homelessness, food insecurity, sudden or unexpected loss, or medical trauma.

Trauma survivors typically develop an “Early Warning System,” alerting against perceived danger. For example, suppose your parents fought a lot when you were a child. In that case, you are likely to be especially sensitive to tension, conflict, or discord around you. This additional sensitivity offers insight as to why today’s upheavals are incredibly stressful for trauma survivors.

 If this sounds like you or someone you know, what can you do?

Become fully aware of your feelings and name them.

If you’re watching the news at home and feel panic starting to flood your system, become consciously aware of your reactions. After acknowledging your feelings, recall that you have heightened sensitivity to current events because of your past traumas. Try watching the feelings as, in most cases, they will fade in time. Also, this is an excellent time to change your environment, like going for a walk.

Use your support system.

By putting your truth on the table with someone you trust and acknowledging the impact it’s having on you, you’re gaining control over the uncontrollable. You’re also modeling to others that it’s okay for them to share with you. If you have a limited support system, it might help do some resourcing online or in therapy.

Self-care is important.

Stretching, yoga, journaling, meditation, cooking, or watching comedy can help you feel safe and present. Taking good care of ourselves requires making your needs a priority. As we take better care of ourselves, we will show up as a better partner, parent, worker, and friend.  

If what helps you happens to be watching puppy videos on Instagram, please tag us so we can also enjoy a little puppy Prozac!

Be kind to yourself.

The world was stressful before 2020, and it certainly doesn’t seem to be winding down any time soon. Allow yourself to feel sad, scared, stressed, exhausted—whatever comes up. Give yourself time to acknowledge and validate these feelings. You may find it helpful to acknowledge at least one positive for every negative thing you noticed.Are you struggling to go back into the office? Remember that you now have half the traffic you used to  Struggling trusting yourself? Remember, it’s okay to not feel like the authority after your entire world has changed. Ask someone you trust what their honest evaluation is of the situation.

Making small adjustments like this work to help you to keep you in balance.

If there was ever an appropriate time to feel a little crazy, this is it. If you find that your internal alarms are going off an awful lot lately, remember you are hardly alone, and at least you know your system is working! Finally, if you are struggling to turn them off, we are happy to connect you with help. Feel free to call us at 866-522-2472 or drop us a line at bizoffice@birchcounseling.com.  


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Accepting what is versus chasing happy

Somewhere, somehow most of us have learned that a happy life means never having to feel anything other than positive emotions.  When sadness visits, or anger, or disappointment, it feels sick, like something is wrong with us. It feels as though we are not enough, our lives are not enough.  We try to distract from negatives and chase happy feelings, only to fall short again and again.

What if we could learn to work with these “negative” feelings in a way that better informs us?  Accepting and being curious about the entire range of our emotions can help us become more compassionate, healthy and ultimately more resilient.